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Lakeside Memorial Hospital Inc
Brockport, NY 14420
| Bed count | 61 | Medicare provider number | 330037 | Member of the Council of Teaching Hospitals | NO | Children's hospital | NO |
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)
(as % of total functional expenses)
Community Benefit Expenditures: 2013
All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Operating expenses $ 16,591,273 Total amount spent on community benefits as % of operating expenses$ 864,906 5.21 %- Amount spent in the following IRS community benefit categories:
Financial Assistance at cost as % of operating expenses$ 66,890 0.40 %Medicaid as % of operating expenses$ 798,016 4.81 %Costs of other means-tested government programs as % of operating expenses$ 0 0 %Health professions education as % of operating expenses$ 0 0 %Subsidized health services as % of operating expenses$ 0 0 %Research as % of operating expenses$ 0 0 %Community health improvement services and community benefit operations*
as % of operating expensesNote: these two community benefit categories are reported together on the Schedule H, part I, line 7e.$ 0 0 %Cash and in-kind contributions for community benefit* as % of operating expenses$ 0 0 %Community building*
as % of operating expenses$ 0 0 %- * = CBI denoted preventative categories
- Community building activities details:
Did tax-exempt hospital report community building activities? Not available Number of activities or programs (optional) 0 Physical improvements and housing 0 Economic development 0 Community support 0 Environmental improvements 0 Leadership development and training for community members 0 Coalition building 0 Community health improvement advocacy 0 Workforce development 0 Other 0 Persons served (optional) 0 Physical improvements and housing 0 Economic development 0 Community support 0 Environmental improvements 0 Leadership development and training for community members 0 Coalition building 0 Community health improvement advocacy 0 Workforce development 0 Other 0 Community building expense
as % of operating expenses$ 0 0 %Physical improvements and housing as % of community building expenses$ 0 Economic development as % of community building expenses$ 0 Community support as % of community building expenses$ 0 Environmental improvements as % of community building expenses$ 0 Leadership development and training for community members as % of community building expenses$ 0 Coalition building as % of community building expenses$ 0 Community health improvement advocacy as % of community building expenses$ 0 Workforce development as % of community building expenses$ 0 Other as % of community building expenses$ 0 Direct offsetting revenue $ 0 Physical improvements and housing $ 0 Economic development $ 0 Community support $ 0 Environmental improvements $ 0 Leadership development and training for community members $ 0 Coalition building $ 0 Community health improvement advocacy $ 0 Workforce development $ 0 Other $ 0
Other Useful Tax-exempt Hospital Information: 2013
In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.
Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt
as % of operating expenses$ 1,091,107 6.58 %Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program? NO - Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.
Does the organization have a written financial assistance (charity care) policy? YES Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients? YES Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy
as % of operating expenses$ 535,801 49.11 %- Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Reported to credit agency YES Filed lawsuit YES Placed liens on residence Not available Issue body attachments? (an order by the court commanding a sheriff or other official to physically bring before the court a person who is guilty of contempt of court) Not available Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
After enactment of the ACA, has the state in which this tax-exempt hospital is located expanded Medicaid? YES The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
If not, is the state's Medicaid threshold for working parents at or below 76% of the federal poverty guidelines? Not available In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.
Does the state in which the tax-exempt hospital is located have a mandatory community benefit reporting statute? YES
Community Health Needs Assessment Activities: 2013
The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.
Did the tax-exempt hospital report that they had conducted a CHNA? NO Did the CHNA define the community served by the tax-exempt hospital? Not available Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital? Not available Did the tax-exempt hospital make the CHNA widely available (i.e. post online)? Not available Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA? Not available Did the tax-exempt hospital execute the implementation strategy? Not available Did the tax-exempt hospital participate in the development of a community-wide plan? Not available
Supplemental Information: 2013
- Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4A (Expenses $ 9622939 including grants of $ 0) (Revenue $ 5931006) PATIENT HEALTH CARE INCLUDES SERVICES SUCH AS MEDICAL AND SURGICAL PROCEDURES, OBSTETRICS, INTENSIVE CARE, NEWBORN NURSERY, DELIVERY ROOM, RECOVERY ROOM, EMERGENCY ROOM, AND URGENT CARE CENTER.
4B (Expenses $ 4811469 including grants of $ 0) (Revenue $ 2965503) OTHER PROFESSIONAL SERVICES INCLUDED LABORATORY COSTS, RADIOLOGY, INTRAVENOUS THERAPY, RESPIRATORY THERAPY, PHYSICAL THERAPY, AND ELECTROCARDIOLOGY COST INCURRED FOR PATIENT SERVICE
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Facility Information
LAKESIDE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 10: FAMILY SIZE AND EARNINGS BROKEN OUT MONTHLY AND YEARLY DETERMINES WHETHER FREE CARE WILL BE GIVEN.
LAKESIDE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 11: FAMILY SIZE AND EARNINGS BROKEN OUT MONTHLY AND YEARLY DETERMINES THE PERCENTAGE OF CHARITY CARE TO BE PROVIDED.
LAKESIDE MEMORIAL HOSPITAL, INC. PART V, SECTION B, LINE 20D: CHARITY CARE ASSISTANCE IS DETERMINED BY ASSESSING ANNUAL HOUSEHOLD INCOME AND THE NUMBER OF PEOPLE IN THE HOME AND COMPARING IT TO THE FEDERAL POVERTY GUIDELINES FOR THE SAME SIZE HOUSEHOLD. THOSE PATIENTS WHO DO NOT FALL WITHIN THE POVERTY GUIDELINE WILL BE REQUIRED TO SUBMIT ADDITIONAL INFORMATION REDARGING INCOME, LIQUID ASSETS, AND EXPENSES. THE PROGRAM IS GENERALLY DESIGNED SO THAT PATIENTS ARE NOT EXPECTED TO EXPEND MORE THAN 20% OF THEIR INCOME OR 10% OF ASSETS FOR QUALIFYING HEALTHCARE OBLIGATIONS. PATIENTS WHO HAVE EXHAUSTED THEIR INSURANCE BENEFITS AND/OR EXCEED FINANCIAL ELIGIBILITY CRITERIA BUT FACE EXTRAORDINARY MEDICAL COSTS WILL BE TREATED ON A CASE-BY-CASE BASIS.
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Supplemental Information
PART III, LINE 4: COST TO CHARGE RATIO FROM COST REPORT APPLIED BY PATIENT TYPE. BAD DEBT INCLUDED IN COMMUNITY BENEFIT BECAUSE MANY MORE PEOPLE WOULD QUALIFY IF THEY APPLIED, BUT THEY DID NOT GO THROUGH THE PROCESS. THIS IS LIKELY THE CASE WITH MOST OF BAD DEBT.
PART III, LINE 8: COST PER CMS 2552-96 PER WKST D SERIES.
PART III, LINE 9B: LAKESIDE MEMORIAL HOSPITAL WORKS WITH PATIENTS TO ESTABLISH A REASONABLE PAYMENT PLAN PRIOR TO ANY COLLECTION REFERRALS. PATIENTS WHO DO NOT FULFILL THEIR PAYMENT OBLIGATIONS WITHIN SPECIFIED TIME PERIODS WILL BE REFERRED TO A COLLECTION AGENCY FOR FURTHER COLLECTION ACTIVITY.
PART VI, LINE 2: COMMUNITY PERCEPTION SURVEY, INTERVIEW LOCAL PHYSICIANS TO DETERMINE PATIENT SPECIALTY NEEDS.
PART VI, LINE 3: GIVEN BROCHURE, SIGNS IN PATIENT REGISTRATION AREA, MEDICAID LIAISON USED BY CASE MANAGEMENT/SOCIAL WORK STAFF.
PART VI, LINE 4: RURAL, COLLEGE STUDENTS, MIDDLE CLASS AND UNINSURED POPULATION.
PART VI, LINE 6: LAKESIDE MEMORIAL HOSPITAL SERVES AS A HOSPITAL, LAKESIDE BEIKIRCH CARE CENTER IS A NURSING HOME WITH REHABILITATION SERVICES, LAKESIDE FOUNDATION RAISES MONEY FOR THE ENTITIES OF THE HEALTH SYSTEM.
PART VI, LINE 7, REPORTS FILED WITH STATES NY
